Hospital overcrowding is one of the biggest challenges for correct and efficient hospital care. Overcrowding is a complex phenomenon characterized by an imbalance between input and output factors: the number of patients arriving in the ED (input) and the time it takes to treat them and move them out again (throughput). This balance is determined by a range of microlevel and macrolevel variables. Moreover, overcrowding is associated with an increase in patient waiting times, as evidenced by the door-to-needle (time from evaluation to drug administration) and leaving against medical advice (LWBS).
As regards the latter, LWBS is a key factor for deterioration in the health status of patients; this in turn negatively affects throughput, as it increases boarding and exit block (which is directly linked to output factors), therefore perpetuating the problem.
In addition to that, overcrowding also reduces the efficiency of clinical staff, who are less likely to identify signs of a deterioration or initiate appropriate treatment. Finally, the mismatch between a patient’s need for an ICU bed and the availability of these beds leads to hospital overcrowding.
As a consequence, it is essential to understand the complexity of this issue and to develop strategies for its reduction, including those aiming to limit boarding and exit block. In order to do so, a multidisciplinary approach, involving clinicians and operational staff from housekeepers to the CEO, is essential. This requires a combination of data-driven analysis, active leadership and coordination between all departments from ward nurses to the executive board.
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